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Remote Patient Monitoring Mississippi

Private payers, Mississippi Medicaid and employee benefit plans are required to provide coverage for remote patient monitoring services for Mississippi-based telehealth programs affiliated with a Mississippi health care facility.


A one-time telehealth installation/training fee is also reimbursed. 


Source: MS Code Sec. 83-9-353. (Accessed Sept. 2019). 


The Division of Medicaid reimburses for remote patient monitoring: 


• Of devices when billed with the appropriate code, and
• For disease management: 
• A daily monitoring rate for days the beneficiary’s information is reviewed. 
• Only one (1) unit per day is allowed, not to exceed thirty-one (31) days per month.
• An initial visit to install the equipment and train the beneficiary may be billed as a set-up visit. Only one set-up is allowed per episode even if monitoring parameters are added after the initial set-up and installation. 
• Only one (1) daily rate will be reimbursed regardless of the number of diseases/chronic conditions being monitored.


Source: MS Admin. Code Title 23, Part 225, Rule. 2.5. (Accessed Sept. 2019). 


Conditions


To qualify for reimbursement patients must meet all of the following criteria:


• Be diagnosed in the last 18 months with one or more chronic condition, as defined by CMS.
• Have a recent history of costly services use due to one or more chronic conditions as evidenced by two or more hospitalizations, including emergency room visits in the past twelve months; and
• The patient’s healthcare provider recommends disease management services via remote patient monitoring.


Source: MS Code Sec. 83-9-353. (Accessed Sept. 2019). 


The Division of Medicaid covers remote patient monitoring, for disease management when medically necessary, prior authorized by the Utilization Management/Quality Improvement Organization (UM/QIO), Division of Medicaid or designee, ordered by a physician, physician assistant, or nurse practitioner for a beneficiary who meets the following criteria:


• Has been diagnosed with one (1) or more of the following chronic conditions of diabetes, congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD);
• Has had two (2) or more hospitalizations in the previous twelve (12) months for one (1) of the chronic conditions listed above; 
• Hospitalizations for two (2) different chronic conditions cannot be combined to satisfy the two (2) or more hospitalizations requirement; and 
• Is capable of using the remote patient monitoring equipment and transmitting the necessary data or has a willing and able person to assist in completing electronic transmission of data.

The Division of Medicaid covers remote patient monitoring of devices when medically necessary, ordered by a physician, physician assistant or nurse practitioner which includes, but not limited to:


• Implantable pacemakers,
• Defibrillators,
• Cardiac monitors,
• Loop recorders, and
• External mobile cardiovascular telemetry.


Source: MS Admin. Code 23, Part 225, Rule. 2.3. (Accessed Sept. 2019). 


Provider Limitations


Remote patient monitoring services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines. Must be ordered by a physician, physician assistant or nurse practitioner.


Source: MS Admin. Code Title 23, Part 225, Rule. 2.2 & 2.3. (Accessed Sept. 2019). 


A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.


Source: MS Code Sec. 83-9-353(18). (Accessed Sept. 2019). 


Other Restrictions


Remote patient monitoring prior authorization request form must be submitted to request telemonitoring services.
The law lists specific technology requirements.


Source: MS Code Sec. 83-9-353. (Accessed Sept. 2019). 


Remote patient monitoring services must be provided in the beneficiary’s private residence.


Source: MS Admin. Code 23, Part 225, Rule. 2.3(C). (Accessed Sept. 2019).